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Date run 2/27/2015 11:35:47AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Run by Pagel <br /> Facility Information as of 2/27/2015 <br /> Record Selection tdterie: Facility ID FA0010223 <br /> Make changeslcorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : <br /> Owner ID OW0008223 Case Number: H07381 New Owner ID <br /> Owner Name JANOFSKY, JON <br /> Owner DBA RMB GARAGE <br /> Owner Address 715 N HUNTER ST <br /> STOCKTON, CA 952021704 <br /> Home Phone 209-785-3210 <br /> Work/Business Phone 209-467-4431 <br /> Mailing Address PO BOX 168 <br /> MOUNTAIN RANCH, CA 95246-0168 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010223 10183339 <br /> Facility Name RMB GARAGE <br /> Location 715 N HUNTER ST <br /> STOCKTON, CA 95202-1720 <br /> Phone 209-467-4431 X <br /> Mailing Address PO BOX 168 <br /> MOUNTAIN RANCH, CA 95246-0168 <br /> Care of Alice Gonzales <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 13905409 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017223 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JANOFSKY, JON (Circle One) <br /> Account Balance as of 2/27/2015: $453.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Program/Elemem and Description Record ID Employee ID and Name Status New 0.1 Delete <br /> 1920-HMBP-Common Materials PRO520157 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO514237 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512511 EE0000000-HAZ MAT SJC DES Inactiv[ Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510223 EE0000000-HAZ MAT SJC DES Inactivt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533694 Inactivt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the pally identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes ardor Standards and State andsor <br /> Federal Laws. D.1,.-,, 'r•1.. e / �] <br /> APPLICANTS SIGNATURE\? c.�LJ r\9� `CN"l Date /�U r , <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: ���� //�•��� �/ ' r Date �/ // ,��Accccounttoout: �//� Date_/ <br /> COMMENTS.✓`�✓t� `I 1��� �•� �( `-t L� r� ( ILS-""sem (�tL ICY ` ` f/ <br /> W 1 lam, Sc-^�3� -Z (b L ci I A-c — LA)l7j4- tj o � ) rV <br />